Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination, 30 December 2020 (2023)

Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination, 30 December 2020 (1)

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Introduction

This advice is provided to facilitate the development of policy on COVID-19 vaccination in the UK.

The Joint Committee on Vaccination and Immunisation (JCVI) advises that the first priorities for the current COVID-19 vaccination programme should be the prevention of COVID-19 mortality and the protection of health and social care staff and systems. Secondary priorities could include vaccination of those at increased risk of hospitalisation and at increased risk of exposure, and to maintain resilience in essential public services. This document sets out a framework for refining future advice on a national COVID-19 vaccination strategy.

This advice has been developed based on:

  • a review of UK epidemiological data on the impact of the COVID-19 pandemic so far (see reference 1)
  • data on demographic and clinical risk factors for mortality and hospitalisation from COVID-19 (see references 2 and 3)
  • data on occupational exposure (see references 4 to 7)
  • a review on inequalities associated with COVID-19 (see reference 8)
  • Phase 1, 2 and 3 data on the Pfizer-BioNTech mRNA vaccine and the AstraZeneca vaccine, and Phase 1 and 2 data on other developmental COVID-19 vaccines (see references 9 to 20)
  • mathematical modelling on the potential impact of different vaccination programmes (see reference 21)

Considerations

Pfizer-BioNTech vaccine

The committee has reviewed published and unpublished Phase 1, 2 and 3 safety and efficacy data for the Pfizer BioNTech mRNA vaccine. The vaccine appears to be safe and well-tolerated, and there were no clinically concerning safety observations. The data indicates high efficacy in all age groups (16 years and over), including protection against severe disease and encouraging results in older adults. The committee advises that this vaccine be used in the first phase of the programme, according to the priority order set out below. While there is some evidence to indicate high levels of short-term protection from a single dose of vaccine, a 2-dose vaccine schedule is currently advised as this is likely to offer longer lasting protection. (See below).

AstraZeneca vaccine

The committee has reviewed published and unpublished Phase 1, 2 and 3 safety and efficacy data for the AstraZeneca vaccine. The vaccine appears to have a good safety profile, and the data indicates high efficacy in adults aged 18 years and over, including protection against severe disease and encouraging results in older adults. Existing data is consistent with high levels of short-term protection following the first dose of vaccine, with further protection obtained following the second dose of vaccine which may be given between 4 to 12 weeks after the first dose. The committee advises that this vaccine be used in the first phase of the programme, according to the priority order set out below. A 2-dose vaccine schedule is currently advised as this is likely to offer longer lasting protection. (See below)

Vaccine schedule

For both Pfizer-BioNTech and AstraZeneca vaccines, a 2-dose schedule is advised.

In the context of the epidemiology of COVID-19 in the UK in late 2020, the JCVI places a high priority on promoting rapid, high levels of vaccine uptake among vulnerable persons.

Therefore, given data indicating high efficacy from the first dose of both Pfizer-BioNTech and AstraZeneca vaccines, the committee advises that delivery of the first dose to as many eligible individuals as possible should be initially prioritised over delivery of a second vaccine dose. This should maximise the short-term impact of the programme. The second dose of the Pfizer-BioNTech vaccine may be given between 3 to 12 weeks following the first dose. The second dose of the AstraZeneca vaccine may be given between 4 to 12 weeks following the first dose.

JCVI advises that the second vaccine dose should be with the same vaccine as for the first dose. Switching between vaccines or missing the second dose is not advised as this may affect the duration of protection.

Vaccine choice

There have been no clinical trials directly comparing the Pfizer-BioNTech and AstraZeneca vaccines. In Phase 3 trials of the respective vaccines, efficacy against symptomatic disease for the Pfizer-BioNTech vaccine was higher than for the AstraZeneca vaccine. Differences in study setting, study design, study population (age, ethnicity, social demographics, etc), and efficacy endpoints may account for some of the observed differences. Both vaccines give very high protection against severe disease, which is the primary aim of the first phase of the programme, and both vaccines have good safety profiles.

The logistical challenges posed by the storage and distribution requirements for the Pfizer-BioNTech vaccine mean that in some populations, the AstraZeneca vaccine is the only vaccine which can be deployed rapidly, and without substantial vaccine wastage.

JCVI does not advise a preference for either vaccine in any specific population. For operational and programmatic reasons, such as to enable more extensive and timely vaccine coverage, one vaccine may be offered in certain settings in preference over another vaccine.

This statement will be updated following consideration of Phase 3 safety and efficacy data on other COVID-19 vaccines.

Direct protection vs transmission reduction

JCVI has considered a number of different vaccination strategies, including those targeting transmission and those targeted at providing direct protection to persons most at risk.

(Video) COVID-19 vaccines: how does the JCVI decide and implement who gets the vaccine?

In order to interrupt transmission, mathematical modelling indicates that we would need to vaccinate a large proportion of the population with a vaccine which is highly effective at preventing infection (transmission). At the start of the vaccination programme, good evidence on the effects of vaccination on transmission will not be available, and vaccine availability will be more limited. The best use of available vaccine will also, in part, be dependent on the point in the pandemic the UK is at.

Given the current epidemiological situation in the UK, the best option for preventing morbidity and mortality in the initial phase of the programme is to directly protect persons most at risk of morbidity and mortality.

Age

Current evidence strongly indicates that the single greatest risk of mortality from COVID-19 is increasing age and that the risk increases exponentially with age (see references 1 to 3). Mathematical modelling indicates that the optimal strategy for minimising future deaths or quality adjusted life year (QALY) losses is to offer vaccination to older age groups first. These models assume an available vaccine is both safe and effective in older adults (see reference 21). Data also indicates that the absolute risk of mortality is higher in those over 65 years than that seen in the majority of younger adults with an underlying health condition (see below). Accordingly, the committee’s advice largely prioritises based on age.

Age-based programmes are usually easier to implement and therefore achieve higher vaccine uptake. An age-based programme is also likely to increase uptake in those with clinical risk factors as the prevalence of these increases with age.

Older adults resident in care homes

There is clear evidence that those living in residential care homes for older adults have been disproportionately affected by COVID-19 (see references 22 to 25) as they have had a high risk of exposure to infection and are at higher clinical risk of severe disease and mortality. Given the increased risk of outbreaks, morbidity and mortality in these closed settings, these adults are considered to be at very high risk. The committee’s advice is that this group should be the highest priority for vaccination. Vaccination of residents and staff at the same time is considered to be a highly efficient strategy within a mass vaccination programme with the greatest potential impact (see below).

Health and social care workers

Frontline health and social care workers are at increased personal risk of exposure to infection with COVID-19 and of transmitting that infection to susceptible and vulnerable patients in health and social care settings. The committee considers frontline health and social care workers who provide care to vulnerable people a high priority for vaccination. Protecting them protects the health and social care service and recognises the risks that they face in this service. Even a small reduction in transmission arising from vaccination would add to the benefits of vaccinating this population, by reducing transmission from health and social care workers to multiple vulnerable patients and other staff members. This group includes those working in hospice care and those working temporarily in the COVID-19 vaccination programme who provide face-to-face clinical care.

There is evidence that infection rates are higher in residential care home staff (see references 22 to 25), than in those providing domiciliary care or in healthcare workers. Care home workers are therefore considered a very high priority for vaccination.

Prioritisation among health and social care workers

Frontline health and social care workers at high risk of acquiring infection, at high individual risk of developing serious disease, or at risk of transmitting infection to multiple vulnerable persons or other staff in a healthcare environment, are considered of higher priority for vaccination than those at lower risk. This prioritisation should be taken into account during vaccine deployment.

Clinically extremely vulnerable (shielding patients)

Individuals considered extremely clinically vulnerable have been shielding for much of the pandemic (see reference 26). This means that available data is likely to underestimate the risk in this group. Many of those who are clinically extremely vulnerable are in the oldest age groups and will be among the first to receive vaccine. Considering data from the first wave in the UK, the overall risk of mortality for clinically extremely vulnerable younger adults is estimated to be roughly the same as the risk to persons aged 70 to 74 years. Given the level of risk seen in this group as a whole, JCVI advises that persons aged less than 70 years who are clinically extremely vulnerable should be offered vaccine alongside those aged 70 to 74 years of age. There are 2 key exceptions to this, pregnant women with heart disease and children (see below).

Many individuals who are clinically extremely vulnerable will have some degree of immunosuppression or be immunocompromised and may not respond as well to the vaccine. Therefore, those who are clinically extremely vulnerable should continue to follow government advice on reducing their risk of infection. Consideration has been given to vaccination of household contacts of immunosuppressed individuals. However, at this time there is no data on the size of the effect of COVID-19 vaccines on transmission. Evidence is expected to accrue during the course of the vaccine programme, and until that time the committee is not in a position to advise vaccination solely on the basis of indirect protection. Once sufficient evidence becomes available the committee will consider options for a cocooning strategy for immunosuppressed individuals, including whether any specific vaccine is preferred in this population.

Women who are pregnant

There is no known risk associated with giving non-live vaccines during pregnancy. These vaccines cannot replicate, so they cannot cause infection in either the woman or the unborn child.

Although the available data does not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy.

JCVI advises that, for women who are offered vaccination with the Pfizer-BioNTech or AstraZeneca COVID-19 vaccines, vaccination in pregnancy should be considered where the risk of exposure to Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV2) infection is high and cannot be avoided, or where the woman has underlying conditions that put them at very high risk of serious complications of COVID-19. In these circumstances, clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the absence of safety data for the vaccine in pregnant women.

JCVI does not advise routine pregnancy testing before receipt of a COVID-19 vaccine. Those who are trying to become pregnant do not need to avoid pregnancy after vaccination.

Women who are breastfeeding

There is no known risk associated with giving non-live vaccines whilst breastfeeding. JCVI advises that breastfeeding women may be offered vaccination with the Pfizer-BioNTech or AstraZeneca COVID-19 vaccines.

The developmental and health benefits of breastfeeding should be considered along with the woman’s clinical need for immunisation against COVID-19, and the woman should be informed about the absence of safety data for the vaccine in breastfeeding women.

Children less than 16 years of age

Following infection, almost all children will have asymptomatic infection or mild disease. There is very limited data on vaccination in adolescents, with no data on vaccination in younger children, at this time. The committee advises that only those children at very high risk of exposure and serious outcomes, such as older children with severe neuro-disabilities that require residential care, should be offered vaccination with either the Pfizer-BioNTech or the AstraZeneca vaccine. Clinicians should discuss the risks and benefits of vaccination with a person with parental responsibility, who should be told about the paucity of safety data for the vaccine in children aged under 16 years. More detail on vaccination in children is set out in the Green Book – Immunisation Against Infectious Disease.

Persons with underlying health conditions

There is good evidence that certain underlying health conditions increase the risk of morbidity and mortality from COVID-19. When compared to persons without underlying health conditions, the absolute increased risk in those with underlying health conditions is considered generally to be lower than the increased risk in persons over the age of 65 years (with the exception of the clinically extremely vulnerable – see above). The committee’s advice is to offer vaccination to those aged 65 years and over followed by those in clinical risk groups aged 16 years and over. The main risk groups identified by the committee are set out below:

  • chronic respiratory disease, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and severe asthma

  • chronic heart disease (and vascular disease)

  • chronic kidney disease

  • chronic liver disease

  • chronic neurological disease including epilepsy

  • Down’s syndrome

    (Video) December 2020 ACIP Meeting - Welcome & COVID-19 vaccine

  • severe and profound learning disability

  • diabetes

  • solid organ, bone marrow and stem cell transplant recipients

  • people with specific cancers

  • immunosuppression due to disease or treatment

  • asplenia and splenic dysfunction

  • morbid obesity

  • severe mental illness

Other groups at higher risk, including those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill, should also be offered vaccination alongside these groups.

Individuals within these risk groups who are clinically extremely vulnerable are discussed separately (see above). Further advice on risk groups, including clear definitions, are set out in the Green Book - Immunisation Against Infectious Disease.

Mitigating inequalities

Multiple social and societal drivers are recognised to contribute towards increased risk from COVID-19. JCVI considered it important to understand the factors underlying health inequalities in COVID-19 giving due consideration to relevant scientific evidence, ethical principles and vaccine programme deliverability. The issues considered are set out in Annex A).

There is clear evidence that certain Black, Asian and minority ethnic (BAME) groups have higher rates of infection, and higher rates of serious disease, morbidity and mortality. There is no strong evidence that ethnicity by itself (or genetics) is the sole explanation for observed differences in rates of severe illness and deaths. What is clear is that certain health conditions are associated with increased risk of serious disease, and these health conditions are often overrepresented in certain BAME groups. It is also clear that societal factors, such as occupation, household size, deprivation, and access to healthcare can increase susceptibility to COVID-19 and worsen outcomes following infection. These factors are playing a large role in the inequalities being seen with COVID-19.

Good vaccine coverage in BAME groups will be the most important factor within a vaccine programme in reducing inequalities for this group. Prioritisation of persons with underlying health conditions (see above) will also provide for greater vaccination of BAME communities who are disproportionately affected by such health conditions.

The committee’s advice is for NHS England and Improvement, the Department of Health and Social Care, Public Health England (PHE) and the devolved administrations to work together to ensure that inequalities are identified and addressed in implementation. This could be through culturally competent and tailored communications and flexible models of delivery, aimed at ensuring everything possible is done to promote good uptake in BAME groups and in groups who may experience inequalities in access to, or engagement with, healthcare services. These tailored implementation measures should be applied across all priority groups during the vaccination programme.

Occupational vaccination (other than frontline health and social care workers)

The committee considered evidence on the risk of exposure and risk of mortality by occupation. Under the priority groups advised below, those over 50 years of age, and all those 16 years of age and over in a risk group, would be eligible for vaccination within the first phase of the programme. This prioritisation captures almost all preventable deaths from COVID-19, including those associated with occupational exposure to infection. As such, JCVI does not advise further prioritisation by occupation during the first phase of the programme.

Occupational prioritisation could form part of a second phase of the programme, which would include healthy individuals from 16 years of age up to 50 years of age, subject to consideration of the latest data on vaccine safety and effectiveness.

The impact of vaccine delivery on non-pharmaceutical interventions.

In a situation of constrained vaccine supply, population level protection will not be achievable immediately.

Once we have evidence of the impact of the programme on morbidity and mortality among vulnerable persons, the initial phase of the vaccination programme could allow the subsequent relaxation of non-pharmaceutical interventions in some sectors of the population. Government advice on non-pharmaceutical interventions should continue to be followed.

Vaccine priority groups: advice on 30 December 2020

Phase 1 – direct prevention of mortality and supporting the NHS and social care system

JCVI advises that the first priorities for the COVID-19 vaccination programme should be the prevention of mortality and the maintenance of the health and social care systems. As the risk of mortality from COVID-19 increases with age, prioritisation is primarily based on age. The order of priority for each group in the population corresponds with data on the number of individuals who would need to be vaccinated to prevent one death, estimated from UK data obtained from March to June 2020 (see reference 3):

  1. residents in a care home for older adults and their carers
  2. all those 80 years of age and over and frontline health and social care workers
  3. all those 75 years of age and over
  4. all those 70 years of age and over and clinically extremely vulnerable individuals[footnote 1]
  5. all those 65 years of age and over
  6. all individuals aged 16 years[footnote 2] to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality[footnote 3]
  7. all those 60 years of age and over
  8. all those 55 years of age and over
  9. all those 50 years of age and over

It is estimated that taken together, these groups represent around 99% of preventable mortality from COVID-19.

JCVI advises that implementation of the COVID-19 vaccine programme should aim to achieve high vaccine uptake. An age-based programme will likely result in faster delivery and better uptake in those at the highest risk. Implementation should also involve flexibility in vaccine deployment at a local level with due attention to:

  • mitigating health inequalities, such as might occur in relation to access to healthcare and ethnicity

  • vaccine product storage, transport and administration constraints

  • exceptional individualised circumstances

    (Video) COVID-19 vaccine pandemic response: Dr. Wei Shen Lim chair of the JCVI – UK

  • availability of suitable approved vaccines, for example for specific age cohorts

JCVI appreciates that operational considerations, such as minimising wastage, may require a flexible approach, where decisions are taken in consultation with national or local public health experts. To be assured that outcome is maximised however, JCVI would like to see early and regular comprehensive vaccine coverage data so that the committee can respond if high priority risk groups are unable to access vaccination in a reasonable time frame.

The next phase – further reduction in hospitalisation and targeted vaccination of those at high risk of exposure and/or those delivering key public services

As the first phase of the programme is rolled out in the UK, additional data will become available on the safety and effectiveness of COVID-19 vaccines. This data will provide the basis for consideration of vaccination in groups that are at lower risk of mortality from COVID-19.

The committee is currently of the view that the key focus for the second phase of vaccination could be on further preventing hospitalisation.

Vaccination of those at increased risk of exposure to SARS-CoV-2 due to their occupation could also be a priority in the next phase. This could include first responders, the military, those involved in the justice system, teachers, transport workers, and public servants essential to the pandemic response. Priority occupations for vaccination are considered an issue of policy, rather than for JCVI to advise on. JCVI asks that the Department of Health and Social Care consider occupational vaccination in collaboration with other government departments.

Wider use of COVID-19 vaccines will provide a better understanding of whether they can prevent infection and onward transmission in the population. Data on vaccine impact on transmission, along with data on vaccine safety and effectiveness, will potentially allow for consideration of vaccination across the rest of the population.

As trials in children and pregnant women are completed, we will also gain a better understanding of the safety and effectiveness of the vaccines in these persons.

Further work

JCVI will continually monitor data on vaccines in development. As more Phase 3 data becomes available on candidate COVID-19 vaccines the committee will be able to prepare further advice for policy makers in the UK.

JCVI will review data on vaccine coverage, in particular focusing on inequalities, and the impact of actions being undertaken to mitigate inequalities. Vaccine safety will be continually monitored by the Medicines and Healthcare products Regulatory Agency (MHRA) and PHE, and JCVI will regularly review data on vaccine safety as the programme rolls out. Vaccine efficacy and any potential impacts on transmission will be monitored by PHE. Data will be considered at the earliest opportunity to facilitate discussions on prioritisation after the first phase of the programme.

Background

JCVI met to consider COVID-19 vaccination on:

  • 7 May
  • 3 June
  • 6 July
  • 1 September
  • 29 November
  • 30 November
  • 1 December
  • 22 December
  • 29 December 2020

Between 24 September 2020 and 22 December 2020, a JCVI COVID-19 sub-committee met most weeks to consider key issues in greater depth. The advice provided is to support the government in development of a vaccine strategy for the procurement and delivery of a vaccination programme to the population.

SARS-CoV-2 (COVID-19)

COVID-19 disease first emerged as a cause of severe respiratory infection in Wuhan, China in late 2019. The first 2 cases in the UK were seen in late January 2020. In March 2020, the World Health Organization declared a SARS-Cov-2 pandemic.

In adults, the clinical picture varies widely. A significant proportion of individuals are likely to have mild symptoms and may be asymptomatic at the time of diagnosis. Symptoms are commonly reported as a new onset of cough and fever, but may include headache, loss of smell, nasal obstruction, lethargy, myalgia, rhinorrhoea, taste dysfunction, sore throat, diarrhoea, vomiting and confusion. Fever may not be reported in all symptomatic individuals. Progression of disease, multiple organ failure and death will occur in some individuals.

As with other coronaviruses, SARS-CoV-2 is an RNA virus which encodes 4 major structural proteins. Most vaccine candidates focus on immunisation with the spike glycoprotein, which is the main target for neutralising antibodies following infection. Neutralising antibodies that block viral entry into host cells by preventing interaction between the spike protein and the host cell are expected to be protective.

Pfizer-BioNTech vaccine

The Pfizer-BioNTech vaccine is a lipid nanoparticle-formulated mRNA vaccine. The mRNA encodes the SARS-CoV-2 full length spike protein. The mRNA in the vaccine is translated and transcribed by the body to produce the spike protein. The protein then acts as an intracellular antigen to stimulate the immune response. The mRNA in the vaccine is normally degraded within a few days and cannot incorporate into the host genome. Data from the Pfizer-BioNTech vaccine trials undertaken in over 40,000 individuals indicate high vaccine efficacy, with no serious safety concerns observed.

AstraZeneca COVID-19 vaccine

The AstraZeneca COVID-19 vaccine uses a replication deficient chimpanzee adenovirus as a vector that encodes the full-length SARS-CoV2 spike protein. Chimpanzee adenoviruses are non-enveloped viruses, meaning that the glycoprotein antigen is not present on the surface of the vector, but is only expressed at high levels once the vector enters the target cells. Genes are deleted from the adenovirus to render the virus replication incompetent, and to enhance immunogenicity. Once the vector is in the nucleus, mRNA encoding the spike protein is produced that then enters the cytoplasm. This leads to translation of the target protein which acts as an intracellular antigen. Data from vaccine trials undertaken indicate high vaccine efficacy, with no serious safety events related to the vaccine.

Other vaccines in development

Other COVID-19 vaccines are in development, with some in late stage trials. When sufficient data on vaccine safety and efficacy are available, these will be considered by JCVI and this statement will be updated.

References

  1. National COVID-19 surveillance reports

  2. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020 Aug;584(7821):430-436.

  3. Clift AK, Coupland CAC, Keogh RH et al. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study. BMJ. 2020 Oct 20;371:m3731.

  4. Coronavirus (COVID-19) related deaths by occupation, before and during lockdown, England and Wales: deaths registered between 9 March and 30 June 2020, Office for National Statistics

  5. Meyerowitz EA, Richterman A, Gandhi RT et al. Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors. Ann Intern Med. 2020 Sep 17:M20-5008.

  6. Lally C. COVID-19 and occupational risk

  7. Mutambudzi M, Niedzwiedz C, Macdonald et al. Occupation and risk of severe COVID-19: prospective cohort study of 120,075 UK Biobank participants medRxiv 2020.05.22.20109892.

    (Video) COVID-19: Dr. Anthony Harnden explains how catching the infection has affected him

  8. Public Heath England report - Beyond the data: Understanding the impact of COVID-19 on BAME groups

  9. Voysey M, Clemens SAC, Madhi SA, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of 4 randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2020 Dec 8:

  10. Polack FP, Thomas SJ, Kitchin N et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020 Dec 10.

  11. Jackson LA, Anderson EJ, Rouphael NG et al. An mRNA Vaccine against SARS-CoV-2 - Preliminary Report. N Engl J Med. 2020 Nov 12;383(20):1920-1931.

  12. Corbett KS, Flynn B, Foulds KE et al. Evaluation of the mRNA-1273 Vaccine against SARS-CoV-2 in Nonhuman Primates. N Engl J Med. 2020 Oct 15;383(16):1544-1555.

  13. Anderson EJ, Rouphael NG, Widge AT et al. mRNA-1273 Study Group. Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults. N Engl J Med. 2020 Sep 29.

  14. van Doremalen N, Lambe T, Spencer A et al. ChAdOx1 nCoV-19 vaccine prevents SARS-CoV-2 pneumonia in rhesus macaques. Nature. 2020 Jul 30.

  15. Folegatti PM, Ewer KJ, Aley PK et al. Oxford COVID Vaccine Trial Group. Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. Lancet. 2020 Aug 15;396(10249):467-478.

  16. Ramasamy M, Minassian A, Ewer K et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. Lancet Nov 18 2020.

  17. Mulligan MJ, Lyke KE, Kitchin N et al. Phase 1/2 study of COVID-19 RNA vaccine BNT162b1 in adults. Nature. 2020 Aug 12.

  18. Sahin U, Muik A, Derhovanessian E et al. Concurrent human antibody and T H 1 type T-cell responses elicited by a COVID-19 RNA vaccine. medRxiv [Preprint]. 2020 July 20.

  19. Walsh EE, Frenck R, Falsey AR et al. RNA-Based COVID-19 Vaccine BNT162b2 Selected for a Pivotal Efficacy Study. medRxiv [Preprint]. 2020 Aug 20.

  20. Keech C, Albert G, Cho I et al. Trial of a SARS-CoV-2 Recombinant Spike Protein Nanoparticle Vaccine. N Engl J Med. 2020 Sep 2.

  21. Moore S, Hill E, Dyson L et al. Modelling optimal vaccination strategy for SARS-CoV-2 in the UK. MedRxiv 2020.09.22.20194183.

  22. Ladhani SN, Chow JY, Janarthanan R et al. Investigation of SARS-CoV-2 outbreaks in 6 care homes in London, April 2020. EClinicalMedicine. 2020 Sep 9:100533.

  23. Ladhani SN, Chow JY, Janarthanan R et al. London Care Home Investigation Team. Increased risk of SARS-CoV-2 infection in staff working across different care homes: enhanced CoVID-19 outbreak investigations in London care Homes. J Infect. 2020 Jul 29;81(4):621–4.

  24. Graham NSN, Junghans C, Downes R, et al. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect. 2020 Sep;81(3):411-419.

  25. Vivaldi 1: coronavirus (COVID-19) care homes study report

  26. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19

  1. See description of Clinically extremely vulnerable individuals. This advice on vaccination does not include all pregnant women or those under the age of 16 years (see above).

  2. The Pfizer-BioNTech vaccine is authorised in those aged 16 years and over. The AstraZeneca vaccine is only authorised for use in those aged 18 years and over.

  3. This also includes those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill.

FAQs

What does green book provide? ›

The Green Book is guidance issued by HM Treasury on how to appraise policies, programmes and projects. It also provides guidance on the design and use of monitoring and evaluation before, during and after implementation.

Who is eligible for Covid autumn booster? ›

An additional seasonal booster (known as 'autumn booster') is available from 5 September 2022 for people who are at high risk from Covid-19. People who are eligible for the autumn booster are: Over 50 years old. Over 5 years old who are in a clinical risk group.

When can I have my next Covid vaccine? ›

You can have your seasonal booster if it's been at least 3 months since you had your previous dose. If you have not had a 1st or 2nd dose of the COVID-19 vaccine yet, you should have them as soon as possible.

Who is getting Covid booster in UK? ›

Seasonal boosters

A seasonal booster (autumn booster) can be booked online for anyone who is: aged 50 or over. pregnant. aged 5 and over and at high risk due to a health condition.

Who invented the Green Book? ›

But in 1936, Victor Hugo Green, a black postal worker, created a guide that would allow African Americans to embrace the adventure and road trips enjoyed by their white counterparts. The result was The Negro Motorist Green Book, the most popular guide for black travelers for three decades.

Who does the Green Book apply to? ›

Known as the Single Status Agreement, the Green Book covers the pay and conditions for 1.4 million local authority employees, ranging from architects to cleaners and lawyers to school meals staff. These agreements are also used to determine the pay and conditions of non-local authority staff.

Who should have the 4th Covid vaccine? ›

People aged 12 and over who had a severely weakened immune system when they had their first 2 doses, will be offered a 3rd dose and a booster (4th dose).

Is Pfizer or Moderna better? ›

Both of the mRNA vaccines available in the US are highly effective against severe COVID-19, but recent studies suggest that Moderna's elicits a stronger immune response and might be better at preventing breakthrough infections.

Can Spikevax be used as a booster? ›

A booster dose of Spikevax can be given to adults and adolescents from the age of 12 years, at least 3 months after primary vaccination with Spikevax, or another mRNA vaccine or an adenoviral vector vaccine.

Which Covid vaccine is best for over 65? ›

Getting vaccinated prevents severe illness, hospitalizations and death. People 65 and older who received both doses of either Pfizer or Moderna vaccines showed a 94% reduced risk of COVID-19 related hospitalization. Unvaccinated people should get vaccinated and continue masking until they are fully vaccinated.

How long does Covid stay in your system? ›

After a positive test result, you may continue to test positive for some time after. You may continue to test positive on antigen tests for a few weeks after your initial positive. You may continue to test positive on NAATs for up to 90 days.

Is AstraZeneca still being used in UK? ›

The COVID-19 Vaccine AstraZeneca authorised under Regulation 174 remains in use and its product information has been updated in line with the product information of the GB CMA .

What is classed as fully vaccinated? ›

Being fully vaccinated means that you have finished your vaccine, whether that's one dose or two, and two weeks have passed. You do need two weeks for your immune system to mount its full response. You are then considered fully immunized.

Do you need a booster to travel? ›

Be aware that some countries are requesting evidence that you completed your COVID-19 vaccine course at least 14 days before arriving in their country. They may also require evidence of a booster dose depending on how long ago you completed your COVID-19 vaccine course.

Should I get a booster Covid vaccine UK? ›

Most people also need a booster dose to help improve the protection from the first 2 doses of the vaccine. There is a chance you might still get or spread COVID-19 even if you have a vaccine, so it's important to follow advice about how to avoid catching and spreading COVID-19.

Is the Green Book still printed? ›

In 1964, the Civil Rights Act finally banned racial segregation in restaurants, theaters, hotels, parks and other public places. Just two years later, the Green Book quietly ceased publication after nearly 30 years in print.

Why was the Green Book no longer published? ›

Shortly after passage of the Civil Rights Act of 1964, which outlawed the types of racial discrimination that had made the Green Book necessary, publication ceased and it fell into obscurity.

When was the last green book printed? ›

It will be a great day for us to suspend this publication for then we can go wherever we please, and without embarrassment. Green died in 1960, four years before the passage of the 1964 Civil Rights Act greatly reduced the need for the Green Book, which ceased publication in 1967.

Has the NJC pay award 2022 been agreed? ›

The employer's side have responded with a pay offer for 2022/23 for an increase of £1,925 on all NJC pay points, with effect from 1 April 2022.

Has local government pay been agreed? ›

We have now received advice that the pay increase for this year has been agreed.

What is the latest version of the Green Book? ›

The new 2021 Edition brings the specifications in the "Greenbook" completely up to date in accordance with best practices and the latest technologies.

Which is the best booster vaccine? ›

Evidence shows that mRNA vaccines work best as boosters, even if you received a different vaccine for your first two doses. This means that even if you had AstraZeneca for your first two doses, you will be offered Pfizer or Moderna for your booster dose.

Can you get Covid after booster? ›

People who are vaccinated may still get COVID-19. When people who have been vaccinated get COVID-19, they are much less likely to experience severe symptoms than people who are unvaccinated.

Which booster is best for Omicron? ›

1 bivalent booster had a better immune response against COVID-19 Omicron subvariant BA. 1 compared with those who received the original (monovalent) booster. The Moderna part of the study evaluated 600 adults age 18 years and older, while the Pfizer-BioNTech part of the study looked at 600 people age 55 and older.

Which is better Moderna or Pfizer Delta? ›

Compared with those who received the Moderna vaccine, recipients of the Pfizer vaccine had a 27% higher risk of documented SARS-CoV-2 infection and a 70% higher risk of COVID-19 hospitalization when Alpha was the predominant variant.

Does Novavax affect the heart? ›

Myocarditis (inflammation of the heart) and pericarditis (inflammation of the membrane around the heart) can occur after Novavax. Cases have been reported in the clinical trial and in post-licensure use in Australia. These rare effects on the heart typically occur: within 1 to 5 days of vaccination.

Is Spikevax better than Pfizer? ›

Data for U.S. vaccinated adults between April – November 20212 shows that Moderna is consistently more protective against COVID-19 infection and death compared with Pfizer.

Is Moderna the same as Pfizer? ›

Moderna uses the same mRNA technology as Pfizer-BioNTech and had a similarly high efficacy at preventing symptomatic disease when the companies applied for authorization; it also needs to be stored in freezer-level temperatures. Who can get it: Infants, children, and adults ages 6 months and older in the U.S.

Can you mix Pfizer and Moderna? ›

Public health has also made it clear that it is safe to mix and match Pfizer and Moderna COVID vaccines for booster shots.

Which vaccine is best for 70 year old? ›

These are five important vaccines to consider if you are age 65 or older:
  1. COVID-19 vaccine. Children ages 12 and older are now eligible to get vaccinated against COVID-19. ...
  2. Influenza (flu) vaccine. ...
  3. Pneumonia vaccine. ...
  4. Shingles vaccine. ...
  5. Tetanus and pertussis.

What vaccines should a 70 year old have? ›

Most people get vaccinated as children, but you also need booster shots as you get older to stay protected against these diseases. The CDC recommends that adults get a Tdap (tetanus, diphtheria, and pertussis) or Td (tetanus, diphtheria) booster shot every 10 years.

Which Covid shot is best for seniors? ›

Pfizer/BioNTech's and Moderna's vaccines require two shots or doses, while J&J's vaccine is one. J&J's one-shot vaccine could alleviate the burden of scheduling two doses, making it ideal for older adults looking to stay at home/shelter in place as the pandemic continues to play out.

How long does immunity last after Omicron? ›

The good news is, researchers found that people's T cells respond effectively to the Omicron variant — even 6 months after their last vaccine dose. So while your immune system might not prevent infection from the Omicron variant, it will likely protect you from becoming very sick.

Can you catch Covid back to back? ›

Reinfection with the virus that causes COVID-19 means a person was infected, recovered, and then later became infected again. After recovering from COVID-19, most individuals will have some protection from repeat infections. However, reinfections do occur after COVID-19.

When does Covid get worse? ›

A person may have mild symptoms for about one week, then worsen rapidly. Let your doctor know if your symptoms quickly worsen over a short period of time.

Which vaccine is safer Pfizer or AstraZeneca? ›

The risk of developing myocarditis and pericarditis is lower after AstraZeneca than after mRNA vaccines (Pfizer or Moderna). Data from the United Kingdom indicate a rate after AstraZeneca of 16 cases per million doses after dose 2 in young people aged 18 to 29 years.

Can I take Pfizer after AstraZeneca? ›

Mixing Pfizer and AstraZeneca vaccines provides strong protection, according to a preliminary study. Administering a first dose of one vaccine and a second dose of the other, in either order, is likely to provide potent protection, the researchers said.

Can AstraZeneca vaccine cause Guillain Barre Syndrome? ›

AstraZeneca's COVID-19 shot joins the list of vaccines flagged for rare Guillain-Barre syndrome. Two months after the FDA flagged Johnson & Johnson's COVID-19 vaccine for the rare nerve disorder Guillain-Barre syndrome (GBS) Europe's drug regulator has done the same for AstraZeneca's COVID shot.

Does fully vaccinated mean you have to have the booster? ›

Yes, you are fully vaccinated even if you haven't gotten your booster yet. The definition of fully vaccinated does not include a COVID-19 booster. Fully vaccinated, however, is not the same as having the best protection.

How long does it take for booster to show up on NHS app? ›

The NHS App has only just been updated to display a 3rd or booster dose. Your medical record will be updated with this information but may take a few weeks to show on the App.

Do airlines require you to be vaccinated? ›

Noncitizens who are nonimmigrants and seeking to enter the United States by air are required to show proof of being fully vaccinated against COVID-19 before boarding a flight to the United States from a foreign country.

Can I travel the day after my booster? ›

COVID-19 booster vaccinations

You should get your COVID-19 booster as soon as you are eligible. If you have received a booster vaccination it will show in your NHS COVID Pass for travel within 5 days.

How long do travel vaccines last? ›

Booster vaccinations are recommended every 3 years if you continue to be at risk of infection.

How do I get my QR code for my vaccine? ›

Generate my vaccination certificate QR code
  1. From the pop-up window with your Certificate of COVID-19 Vaccination, select Generate QR Code.
  2. VAMS will navigate you to a separate window. ...
  3. Click Save.
  4. VAMS will return you to your Recipient Portal.
  5. Click the blue hyperlinked text, View Your Vaccination Certificate.
9 Nov 2021

Who should not take Covid-19 vaccine? ›

If you are allergic to PEG, you should not get an mRNA COVID-19 vaccine. Ask your doctor if you can get the J&J/Janssen vaccine. If you are allergic to polysorbate, you should not get the J&J/Janssen COVID-19 vaccine. Ask your doctor if you can get an mRNA COVID-19 vaccine.

Why do I have to wait 28 days after Covid for booster? ›

This is because evidence suggests that a 12-week gap may reduce the already extremely low risk of heart inflammation after a vaccine. The 12-week gap does not apply to children at higher risk from the virus, including those with health conditions and those who live with vulnerable adults, who should wait for 28 days.

What is the discount rate Green Book? ›

The green book applies a standard discount rate of 3.5% per annum to future benefits and costs.

What is the Green Book in schools? ›

The Little Green Book is a set of promises that, as colleagues, we make to each other and to our organisation for the ultimate benefit of the children and families that our schools serve. Promise One: We will all talk straight and ensure information is communicated effectively. This means we will all: • Be honest.

What is the Green Book 5 case model? ›

The Green Book supports the 5 case model, which is the government's recommended framework for developing business cases. It is also supported by supplementary guidance that addresses appraisal issues relevant to specific policies.

What is Green Book insurance? ›

Green Book can refer to a comprehensive guide for financial institutions processing federal government automated clearing house (ACH) transfers and payments, or a publication that informs the Federal Open Market Committee (FOMC) about market projections to aid them in their monetary policy decisions.

What is the best discount rate to use? ›

An equity discount rate range of 12% to 20%, give or take, is likely to be considered reasonable in a business valuation. This is about in line with the long-term anticipated returns quoted to private equity investors, which makes sense, because a business valuation is an equity interest in a privately held company.

How do you pick a discount rate? ›

In other words, the discount rate should equal the level of return that similar stabilized investments are currently yielding. If we know that the cash-on-cash return for the next best investment (opportunity cost) is 8%, then we should use a discount rate of 8%.

What is a healthy discount rate? ›

Based on assumptions about the pure utility discount rate, the elasticity of marginal utility, the growth rate of income, and the extent to which health affects income, these authors estimate that the discount rate on health effects should be 1% to 3.5% lower than the discount rate on costs [13].

Will council workers get a pay rise in 2022? ›

It will be backdated to 1 April 2022 and averages out to around 7% across the pay spine with the flat rate seeing those at the bottom of the spine (the lowest paid) receive a 10.5% increase with those at the top, just over 4%.

What is OBC and FBC? ›

Outline business case (OBC) and full business case (FBC) checklist.

What is a 5 case? ›

The Five Case Model provides a disciplined, step by step approach that helps to ensure that each of the key aspects of a robust investment proposal is explicitly and systematically addressed as part of the business case development process.

What is a yellow book in insurance? ›

Yellow Book — the annual reporting form for property and casualty insurers in the United States. Also known as Yellow Peril, for its size and complexity, although with the advent of computerized work sheets and electronic filings, much less of a peril than in the days of typewriters and calculators.

Do you need a green card to get life insurance? ›

Do you have to be a U.S. citizen to have life insurance? You do not have to be a U.S. citizen to buy a life insurance policy in the U.S. Life insurance is available for temporary and permanent U.S. residents, such as visa and green card holders.

Is a Blue Book the same as a green book? ›

The difference between green and blue books is that the green books contain a minimum of 30 percent post-consumer waste content such as old magazines, newspapers and office paper, but blue books have no recycled content.

Videos

1. COVID-19 vaccine: why should social care staff and care home workers have the vaccine?
(UK Health Security Agency)
2. Who is eligible for the COVID-19 vaccine in the UK and how are the priority groups decided?
(UK Health Security Agency)
3. COVID-19 vaccine: as a GP what would you say to health professionals about having the vaccine?
(UK Health Security Agency)
4. Coronavirus data briefing (30 December 2020)
(10 Downing Street)
5. Recommendations of the National Advisory Committee on Immunization (NACI) on the use of the Moderna
(NCCID • CCNMI)
6. COVID-19 Vaccines and Herd Immunity
(JAMA Network)
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